Letter to the Editor

Congratulations on the recent re-release of the International Journal of Naturopathic Medicine and the focus on peer-reviewed articles for the naturopathic profession.

As the profession expands the need for consistency in the use of terminology is critical. It is also imperative that we recognize that naturopathic definitions are often different than conventional medicine. My current concern is the use of the term “cause” or “etiology”. As one of the principles of naturopathic medicine is to “treat the cause” . . . . I recommend that we clearly define what that means from a naturopathic perspective.

The wholistic and vitalistic approach of naturopathic medicine includes the recognition that physiological imbalances are the result of an individual responding to intrinsic and extrinsic factors. It is the extrinsic factors and the initiators of the intrinsic factors that are the true root causes of disease.

In literature the terms causal, risk, concomitant, associated and biological factors are used interchangeably. There is often little effort or focus on distinguishing the difference between how the functional body “responded” and “reacted” with notable signs and symptoms and what caused the body to respond. It is the what that links to the causal factors; not the how.

Signs and symptoms are never the cause of disease. I would argue that causal factors are those factors that disrupt the normal functioning of the body. Hence, the causes of disease include lifestyle factors (food, water, breathing, posture, rest, sleep, movement and positive mental state); social factors (family, school or work and community dynamics); external factors (medical treatments, drugs, accidents, injuries, exposure to chemicals and toxins, etc) and environmental factors (air, water, soil, pollution, pathogens, etc).  Personal essence or an individual’s vitality plays a role, as does genetics, especially for young children.

It is easy to see why there is so much emphasis placed on taking drugs and supplements, geared at changing the physiological milieu, when the “cause” of signs, symptoms and diseases are defined based on biological or physiological responses. For example it is common to find the causal factors of heart attacks listed as hypercholesterolemia, atherosclerosis and hypertension. Extrinsic causes such as emotional stress, dietary imbalances, exposure to cold, strenuous exercise, cigarette smoking etc., are often downplayed or included in the same list with no distinction between the intrinsic physiological responses and the extrinsic causal factors. Identifying the cause of disease in terms of physiological responses makes it easy to dismiss the need and importance of individuals addressing lifestyle, social, external and environmental factors.

The naturopathic principle, ‘treat the cause’, is based on the understanding that health and disease are logical and that there are factors that contribute and account for an individual’s overall state of well-being. In the literature and in medical textbooks, even some naturopathic textbooks, it is common for the cause or etiology of diseases to be stated as unknown. This statement allows the doctor “freedom” in addressing only physiological responses as opposed to causal factors. A naturopathic assessment recognizes that the link to causal factors lies with the patient’s subjective view of their life, with their lifestyle and with external, social and environmental factors. The concepts of total body burden and toxic load provide us with the understanding that cause is often multi-factorial and even if a single cause can not be identified it is imperative and essential to identify as many causal factors as possible.

Identifying the causal factors of disease is often more time-consuming than identifying the physiological reactions of the body. Both are necessary to effectively provide treatment, but there is a difference.  Too often the factors that initiated the disruption (the causal factors) are not addressed and instead the body is faced with the continual presence of the disrupting factors and treatments that are focused on managing the physiological response.  I hope that we recognize the uniqueness of our principles and that, as a profession, we take the time to clearly define our approach to health and disease.

Iva Lloyd, ND

Past Chair – Canadian Association of Naturopathic Doctors